Prospects of Using Microwave Radiothermometry in Early Diagnosis of Endometritis and Uterine Suture Failure After Abdominal Birth

I. I. Kutsenko, I. O. Borovikov, M. V. Galustyan, A. S. Magay, O. I. Borovikova
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Abstract

Aim: To assess the capabilities of microwave radiothermometry (MRTM) in early diagnosis of Postpartum endometritis and uterine suture failure after caesarean section. Design: Prospective non-randomized clinical trial. Materials and methods. A comparative analysis of the sensitivity of ultrasound (ultrasound) with dopplerometry and MRTM in the diagnosis of endometritis and suture failure on the uterus after cesarean section was carried out. The study included puerperal women after abdominal delivery (n = 90): 24 patients with a puerperia complication in the form of endometritis (group I), 16 — with suture failure on the uterus (group II), 50 — with a physiologically occurring postoperative period (control group). Assessment of the condition of the uterus and the postoperative suture on it was carried out on the 3–4th day after the operation. Results. Despite the fact that ultrasound with dopplerometry assessment of blood flow in the branches of the uterine arteries makes it possible to assess the structure of the myometrium and with a fairly high degree of probability to identify its inflammatory changes and defects in the suture, the sensitivity of this method in the early (3–4th day of the postoperative period) diagnosis of endometritis after abdominal delivery reaches an average of 54.2 ± 23.5%, and in the insolvency of the suture on the uterus — 31.25 ± 14.65%. At the same time, the MRTM study revealed indirect signs of endometritis in 66.7 ± 7.9% (if the conclusion is based on only one parameter — the thermoassymetry index, ITA) and 87.5 ± 8.3% (taking into account the combination of three signs), and for the insolvency of the suture on the uterus, the sensitivity of the method is 81.25 ± 4.75% for both ITA and three thermogram parameters, which is 2.6 times higher, than with ultrasound. Conclusion. Despite the rather high diagnostic effectiveness of the ultrasound method for assessing the condition of the scar on the uterus after cesarean section, the MRTM method has advantages in the form of higher sensitivity, ease of implementation, no need for expensive equipment and specialized medical qualifications. The greatest effectiveness of the diagnosis of postpartum purulent-septic complications can be achieved only with an integrated approach with clinical and laboratory tests and functional diagnostics, and timely prevention and an integrated approach to the treatment of purulent-inflammatory diseases of postoperative puerperia contribute to a significant reduction in the frequency of severe forms of postpartum infection. Keywords: caesarean section, endometritis, uterine suture failure, ultrasound, microwave radiothermometry, hysteroscopy.
微波放射测温仪在腹部分娩后子宫内膜炎及子宫缝合失败早期诊断中的应用前景
目的:探讨微波放射测温仪(MRTM)对剖宫产术后子宫内膜炎及子宫缝合失败的早期诊断价值。设计:前瞻性非随机临床试验。材料和方法。比较分析超声(超声)与多普勒术、MRTM对剖宫产术后子宫内膜炎及子宫缝合失败的诊断敏感性。本研究纳入了经腹分娩后的产褥期妇女(n = 90): 24例出现子宫内膜炎形式的产褥期并发症(I组),16例子宫缝合失败(II组),50例出现生理性术后并发症(对照组)。术后3 - 4天评估子宫状况并进行子宫术后缝合。结果。尽管超声多普勒法评估子宫动脉分支血流,可以评估子宫肌层的结构,并有相当高的概率识别其炎症变化和缝合缺陷,但该方法在腹部分娩后子宫内膜炎早期(术后3 - 4天)诊断的敏感性平均为54.2±23.5%。而子宫上无缝线者- 31.25±14.65%。同时,MRTM研究显示子宫内膜炎的间接体征为66.7±7.9%(如果仅根据一个参数-热不对称指数ITA得出结论)和87.5±8.3%(考虑三个迹象的组合),对于子宫缝合不全,该方法对ITA和三个热成像参数的敏感性为81.25±4.75%,比超声高2.6倍。结论。尽管超声方法在评估剖宫产术后子宫瘢痕状况方面具有较高的诊断效能,但MRTM方法具有灵敏度高、易于实施、不需要昂贵的设备和专业的医疗资质等优点。只有结合临床、实验室检查和功能诊断,才能最大限度地提高产后脓毒性并发症的诊断效果,及时预防和综合治疗产后产褥期脓性炎性疾病,有助于显著减少产后严重感染的发生频率。关键词:剖宫产,子宫内膜炎,子宫缝合失败,超声,微波放热,宫腔镜。
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